As a healthcare Group, we are responsible not only for the well-being of our patients, but also for the health and safety of our employees. We have implemented numerous management systems and measures throughout the Group to prevent employee accidents and work-related illnesses. Creating a safe and healthy working environment is our top priority. In health protection, prevention is our guiding principle; this is why we offer our employees comprehensive programs that promote their health and prevent occupational diseases.
Our approach to occupational health and safety is explained below. In addition, the reporting on this includes these topics:
Our approach
Ensuring the health and safety of our employees is an essential part of our corporate responsibility. The Fresenius Code of Conduct states that we must take the necessary measures to protect our employees and to prevent work-related accidents. All business segments focus on preventive measures and on the individual responsibility of employees when it comes to occupational health and safety. The occupational safety concepts are adapted to the specific business models of the business segments. These focus on occupational health and safety within production, as well as occupational health management for healthcare facility or administrative employees.
The following principles are considered:
- implementing the necessary measures to ensure the health and safety of employees,
- provision of appropriate information, training, and instruction to employees and all persons at our locations,
- ensuring and supporting continuous improvement,
- preventing work-related injuries, illnesses, and other incidents, e. g., implementing technical protection measures,
- performing hazard and risk assessments for all routine and non-routine activities,
- complying with applicable legal requirements and other occupational health and safety requirements,
- providing and ensuring the continuous safe operation of facilities, machinery, and equipment,
- safe handling, use, storage, and proper disposal of hazardous substances.
These principles are derived from the provisions set out in ISO 45001.
The aim of all the measures is not only to protect employees, but also to ensure the health and safety of patients. All Fresenius business segments continually record data on occupational health and safety in line with regulatory requirements.
Organization and responsibilities
Occupational health and safety (OHS) is decentrally organized within the Fresenius Group. Within the Fresenius Group Management Board, the Chief Executive Officers (CEOs) of the business segments are responsible for operational management. Responsibility for occupational health and safety is regulated by the respective Management Boards of the business segments, their committees or management functions. They decide on the management approaches and responsibilities, e. g., via a business allocation plan. The business allocation plan of the Fresenius Group Management Board does not provide for a separate department for this purpose. As part of risk reporting, the Fresenius Group Management Board is informed quarterly about occupational health and safety, i. e., about risks or incidents that could have a significant impact on the operating business, the reputation or the value chain of the Group and its business segments. The Audit Committee of the Supervisory Board is informed of these developments on a quarterly basis, as well. The Supervisory Board is informed on an annual basis. For further information, please refer to the Risk Report and the Compliance section in the Non-Financial Group Report.
The business segments have internal specialists that ensure that the respective guidelines and regulatory requirements as well as specific frameworks for the local entities are applied. They define management approaches as well as company-wide guidelines for the business segments. Data on OHS is recorded and reported regularly, for example on a monthly or quarterly basis, to identify deviations. If deviations occur, our specialists initiate root cause analysis and evaluation, and corrective or preventive actions are implemented where necessary. Regular internal audits, in some cases annually, support the verification of data and management approaches, for entities both certified in accordance with ISO 45001 and without certification. Thus, we ensure that internal guidelines and regulatory provisions are complied with.
Physical and mental health and safety risks are identified, analyzed and evaluated at workplace level and reduced to an acceptable level through targeted measures, or even completely eliminated. The corresponding risk assessments are carried out at regularly – often at least once a year – and in close consultation with the respective department heads and local responsible experts. Corresponding documentation is provided in the safety and health protection documents.
If an entity, be it in production or in the clinical setting, uses biological agents, these substances are evaluated in accordance with the applicable legal regulations. The corresponding internal risk assessment is recorded in a health and safety document and preventive measures are established before the respective process is initiated.
The ISO 45001 certified sites have an occupational health and safety committee. In addition, national requirements are to be applied, which might also include the provision to establish health and safety committees. At their meetings, the committees discuss identified risks and possible measures, and also review the effectiveness of the defined measures. At clinic locations in Germany and Spain, local employee representatives have also formed respective committees. At Fresenius Vamed, staff from temporary employment agencies can also participate in occupational health and safety committees or are informed about decisions.
Fresenius Medical Care
In the reporting year, Fresenius Medical Care established an Occupational Health and Safety function within its Global Legal department. This function drives the company’s global OHS strategy and manages related activities including setting and monitoring global goals, targets, and Key Performance Indicators (KPIs). In the reporting year, the business segment also agreed on several short-, mid- and long-term OHS targets that will form the basis of its global OHS strategy.
Fresenius Kabi
Responsibility for occupational health and safety management at Fresenius Kabi is anchored in the management board areas and local organizations; global management responsibility lies with the central organization, which reports to the responsible member of Fresenius Kabi’s Management Board.
Fresenius Kabi has implemented standard operating procedures (SOPs) and further instructions as well as guidelines to provide a global framework for occupational health and safety. A management handbook and additional SOPs provide a consistent framework for the local occupational health and safety management of ISO 45001 certified organizations.
Experts in the central OHS function analyze and evaluate occupational health and safety programs, working procedures, risks, and objectives, and facilitate exchange of information about occupational health and safety throughout the company. Risk assessment is an important part of occupational health and safety management. Based on the outcomes of risk assessment, occupational health and safety measures are developed and implemented locally. According to global SOPs, OHS risks must be reviewed at least annually or in case of operational changes or, accidents, for example. Employees are involved in risk assessments.
Fresenius Kabi provides special occupational health services at some locations; these help to identify and eliminate hazards and minimize risks in line with local legislation, e. g., with on-site occupational health service providers or contracted off-site providers.
Fresenius Helios
The senior management team of Helios Germany, the Helios Occupational Health business segment and the Helios Infrastructure segment have the task of coordinating occupational health and safety in Germany.
In terms of organization, the Helios Occupational Safety segment is assigned to the area of Authorized Officers & Environmental Management in the Infrastructure business segment. It currently looks after about two-thirds of all the employees in the division in Germany as well as Xenios, a Fresenius Medical Care company. At local level, we work closely with the relevant accident insurance institutions in the interests of our employees. The Helios Occupational Health business segment in Germany also has an Occupational and Organizational Psychology department.
The members of the local Occupational Health and Safety Committees at Helios Kliniken in Germany take a targeted approach to monitoring the various aspects of occupational safety and health promotion. Meetings are held quarterly by the Occupational Health and Safety Committees. In addition, specialist personnel and managers in special steering groups at the hospital sites work on dealing with specific areas, such as occupational health management. There are also established processes for occupational reintegration management in the clinics in Germany and Spain. People who are reintegrated after a longer period of absence undergo a process accompanied by experts from various specialist departments. The aim is to restore the ability to work within the scope of the individual’s possibilities.
Fresenius Helios hospitals have risk assessments for the individual workplaces and maintain lists of hazardous substances. The risk assessments are to be reviewed every two years and on an ad hoc basis to ensure that they are up to date. As a preventive measure, Helios Germany also conducts occupational health and safety inspections of areas of the hospitals to detect potential risks. The main risk areas are identified via accident reports or information from employees and undergo rigorous assessment. As part of a risk assessment, these are then analyzed. Psychological risks can also be identified through employee surveys as part of a psychological risk assessment. Derived measures are developed in a targeted manner by Helios Occupational Medicine and the supervisor, and implementation is driven forward.
Helios Spain has implemented a policy on workplace safety, which is applicable at all company levels and locations. It is supported and controlled by a management system for health and safety at work that has been coordinated with the health and safety committees and approved by management. It has undergone the legally required audits in Spain, as well as internal audits and certifications. The implementation and monitoring of the OHS system is taken care of by specially authorized employees.
The standardized occupational health and safety approach across its entities is complemented by a company-wide training platform for specific workplace-related risks. Various KPIs, including absenteeism, occupational illness, and work-related injuries, are consolidated for all hospitals on a monthly basis in a single standardized system and are evaluated. Based on this, measures are then taken to reduce absenteeism and prevent accidents at work.
The OHS system includes processes for identifying hazards and deficiencies, assessing risks for incidents, and determining measures for control, correction or mitigation, and prevention, and improvement. These risk assessments comply with applicable legal requirements for risk assessment and the implementation of necessary controls. They include all employees who perform or have access to routine and non-routine activities in Helios Spain workplaces. All current and planned workplaces, procedures, (OHS) processes, and tasks located or performed at the centers, as well as their design, are assessed – as are human factors such as personal behavior. Also covered are the design of infrastructure, equipment, and materials in the workplace, whether provided by Helios Spain or by third parties. The assessments also include hazards that arise in the immediate vicinity of the workplace from work-related activities under the control of the division, as well as those that exist outside the workplace but potentially affect the safety and health of its employees. The risk assessments include both physical and psychosocial risks. In assessing psychosocial risks, Helios Spain identifies those jobs and occupational groups that potentially pose greater psychosocial risks; it also proposes remedial measures. A review of the risk assessments is conducted at least every three years, or more often if required.
In addition, Helios Spain has a procedure for dealing with employees who are particularly at risk (Procedure for Sensitive Workers). The scope of the program includes pregnant women, women who have recently given birth or are breastfeeding, workers with recognized deficiencies or disabilities (physical, mental or sensory), minors, as well as workers who, due to their own personal or socio-occupational characteristics or known biological condition (whether temporary or permanent), are especially sensitive to the risks derived from their work. The purpose is to take special preventive and protective measures by the health monitoring service – on the one hand, when a position in the company is or is to be occupied by persons who are particularly at risk, and on the other hand, when employees can only perform their activities to a limited extent. Such restrictions are identified during examinations of employees in accordance with the occupational health procedure. If a work restriction is identified, Helios Spain adapts the employee’s workplace or transfers his or her activity to another one that is more compatible with the individual’s state of health.
The Fertility Services division is present in 10 countries – and each country has different regulations regarding occupational health and safety. Therefore, each country has its own function responsible for OHS, usually reporting to the Human Resources (HR) department or directly to the local country management. The Compliance Steering Committee at Helios Fertility headquarters monitors compliance with OHS regulations in the various countries during its regular meetings.
Fresenius Vamed
All employees, and in most instances patients and customers too, are covered by the company’s holistic approach to occupational health and safety. Due to the broad range of services and the different responsibilities involved, the implementation process is organized in very different ways throughout the business segment – nationally and internationally. In the area of occupational health and safety, all locations are subject to the respective local laws and regulations. Compliance with these regulations is also ensured at local level. The legal provisions and the supporting internal guidelines, underline the importance of occupational health and safety: the Code of Conduct covers administration and the area of technical services, while the Clinical Code of Conduct regulates the area of healthcare and medical personnel. In Austria, Fresenius Vamed has issued a safety manual valid throughout the country as well as procedural instructions. As part of Fresenius Vamed’s integrated quality management system, they regulate safety and health protection throughout Austria.
To prevent work-related injuries and occupational accidents, all new employees receive safety training at the very beginning of their employment. In Austria, the safety center of Vamed Technical Services employs several safety specialists. This center is responsible for the safety-related support of operations. In order to maintain and further develop their competence, all safety specialists are subject to a focus-specific training program adapted to the respective needs of the organization. In addition, the manager of the safety center is certified as quality, safety, risk, and environmental manager and as lead auditor.
Switzerland has its own safety officers who are responsible for occupational safety and data protection. In addition, there is a dedicated CIRS Circle (Critical Incident Reporting System – CIRS): this is a committee of representatives from different areas, who analyze critical and near-critical situations, in order to develop and implement solutions.
In the Czech Republic, there are not only safety officers, but also a legally required categorization of work into safety levels. This categorization is performed by in-house responsible persons. The categories determine what protective clothing the employer must provide for the respective workplace and the scope of occupational health examinations of the respective employee.
Fresenius Corporate
Occupational safety is regulated for Fresenius Corporate in accordance with statutory requirements and is managed via the Corporate Real Estate Management department. The occupational safety specialists provide advice and support on all issues relating to occupational health and safety. This includes, for example, determining the need for risk assessments as well as their preparation, implementation and effectiveness monitoring.
Patient safety
In addition to the health and safety of our employees, the safety of patients in our facilities is also of great importance. For information on patient safety in the context of medical treatment, please refer to the section Patient and product safety. Beyond that, Fresenius Helios and Fresenius Vamed, for example, have implemented various measures to protect patients from hazardous situations outside of medical treatment. Such hazardous situations can be, for example, fires, power outages or weather-related circumstances, like ice on parking lots or hospital access ramps in winter. If such a situation occurs, appropriate emergency and fire protection plans are in place, for example to ensure the evacuation of patients. The hospital staff are prepared for such crisis situations through annual mandatory training. Business continuity plans for crisis situations complement the existing safety measures.
Certifications and commitment
Our commitment in the business segments regarding OHS is supported, monitored, and certified by external partners or regulatory bodies. The overarching ambition of the management system according to ISO 45001 is to improve occupational health and safety management and ensure the effectiveness of existing procedures and systems. To drive this forward, we are consistently expanding the number of entities certified with this standard. Audits performed by other external bodies are scheduled with the local management.
The applicable occupational health and safety regulations and instructions for employees of the Fresenius Group also apply to individuals with temporary employment contracts. This ensures that people performing work on a company site or in our buildings are protected to the necessary extent.
Fresenius Medical Care
Some of the production sites and dialysisDialysisForm of renal replacement therapy where a semipermeable membrane – in peritoneal dialysis the peritoneum of the patient, in hemo dialysis the membrane of the dialyzer – is used to clean a patient’s blood. clinics of Fresenius Medical Care are certified according to international health and safety standards. These include ISO 45001 in Europe, the Middle East, Africa, as well as Latin America, and the Australian Council on Healthcare Standards (ACHS) in Asia-Pacific. In addition to external audits by relevant authorities, internal reviews and audits are conducted to monitor compliance with corresponding regulations, policies, and procedures.
Fresenius Kabi
A global management system in accordance with the international ISO 45001 standard supports occupational health and safety at Fresenius Kabi. The global management handbook and SOPs provide global management requirements for the certified organizations’ local management. The management system covers all employees as well as temporary workers at certified sites. The certified entities set local targets to enhance the occupational health and safety management. The local management reviews it at least once a year with regard to its continued suitability, appropriateness, effectiveness, and potential for improvement. Global internal audits ensure implementation of the management system. Furthermore, it is audited on an annual basis and certified by TÜV Rheinland.
At Fresenius Kabi, 34 manufacturing plants are certified according to the ISO 45001 standard. The company is working on rolling out the ISO 45001 certification globally to all manufacturing plants by 20231. In 2022, the coverage was 67%.
Fresenius Kabi aims to improve occupational health and safety processes and align them with internationally recognized standards. In 2022, nine additional manufacturing plants were included in the ISO 45001 certification of Fresenius Kabi. The general occupational health and safety standards cover all employees of the business segment.
1 The implementation will be concluded at all manufacturing plants of Fresenius Kabi in 2023. The certification issuance from the individual certification companies may extend into the following year.
Fresenius Helios
Helios Germany has developed its own structured approach to occupational safety and occupational medicine that complies with regulatory requirements. This includes all employees. For more information, see the Organization and responsibilities section.
Based on ISO 45001 and Spanish regulatory provisions, all hospitals at Helios Spain are required to report occupational health and safety incidents along with their cause, lost time, illnesses and absenteeism, as well as other KPIs, in a SAP system and to transmit them to the social security system.
Fresenius Vamed
Fresenius Vamed ensures that the regulatory provisions for occupational health and safety are implemented. The ISO 45001 certifications of entities complement the internal management approaches at selected locations, as well as further ISO certifications or external national certifications like SwissReha. The healthcare facilities in the Czech Republic are audited and accredited to the national standard every three years by an external commission.
Reporting systems
All business segments have notification systems for accidents at work.
Fresenius Medical Care began collecting and reporting on work-related fatalities on a global level in 2021. It further tracks and analyzes accidents at local and regional levels, identifies their root causes, and takes corrective action.
Fresenius Kabi organizations document and analyze all work-related accidents and incidents worldwide – for both its own employees and temporary workers. Occupational accidents are categorized according to their severity and reported to the responsible central OHS function and other relevant functions of the business segment depending on their severity. For example, work-related accidents that result in at least one day of absence must be reported within two working days to the central OHS function; other, less severe accidents without or with less than one day of absence are reported on a quarterly basis. All reported accidents are investigated, and the results are documented in respective reports. Fresenius Kabi also documents first-aid cases and unsafe situations including near misses. These are taken into account in the analysis of occupational health and safety.
Fresenius Helios uses a CIRS for critical incidents and near misses at all hospitals. Further information can be found in the Patient and product safety section.
If an accident occurs in a clinic, a defined process must be followed in order for the person affected to have recourse against the accident insurance organization: the person involved in the accident reports the event to the responsible function depending on the local organizational structure, e. g., the HR department. The clinic must then file a report with the accident insurance organization within a specified period.
At all Fresenius Vamed sites, reporting procedures are in place to identify and prevent work-related injuries. In Austria these are, for example, the reporting of occupational accidents and near-accidents and preventive workplace evaluation. All work-related accidents and all events that almost lead to an accident are documented locally. In addition, the HR department reports all accidents with lost days to the accident insurance, in accordance with country-specific requirements.
Training
Fresenius SE & Co. KGaA and all the business segments conduct regular occupational health and safety training to prevent incidents in their fields of operation, at least on an annual basis for standard programs. For potential incidents with high risk, the training frequency is higher in some cases. Helios Germany, for example, conducts quarterly drills on the power failure scenario, in different parts of the building each time.
In our clinics, employee health and safety training courses cover, besides general topics, specific areas such as the safe use of sharps and disposables, hand hygiene and infection control, as well as prevention of emergencies and their control. Health and safety training provided in our production sites focuses, for instance, on hand hygiene, the safe handling of work equipment, hazardous chemicals, and emergency prevention and response. Training provided at the production sites focuses on, among other topics, the safe handling of work equipment and chemicals, and emergency prevention and response.
In the United States alone, more than 48,000 employees of Fresenius Medical Care completed health and safety training in 2022. Helios Spain also identifies additional training needs for risk prevention in the workplace.
Company reintegration management
In Germany and for Fresenius Vamed in Austria, the statutory company integration management system applies to the Fresenius sites.
In Germany, if an employee is unable to work continuously or repeatedly for more than six weeks within a year, a reintegration procedure is initiated. The relevant employee representatives jointly clarify with the management of the site, and with the consent and participation of the person concerned, the options for overcoming the incapacity for work and what benefits or assistance can be used to prevent renewed incapacity. The aim is to make reintegration flexible and as needs-oriented as possible, thereby ensuring that employees can return to work in the long term. In a first step, affected employees of Fresenius are informed in writing about the options available and about the structure of an initial discussion and its participants. In this context, it is also important to transparently communicate the goals of company reintegration management and the type and scope of the data collected and used for this purpose.
If further measures result from the initial discussion, these can also take place in an extended group in consultation with the person concerned. The extended group may include, for example, supervisors, a member of the works council, the representative of the severely disabled, the company medical service, the company social counseling service, a representative of the company health management, and, if a severe disability or handicap is imminent, a representative of the integration office.
In Austria, the beforementioned measures are initiated in similar form. A separate process description was developed for this purpose, which can be accessed by all employees on the intranet. Affected employees receive what is known as a reintegration allowance from the responsible social insurance agency for the duration of this part-time employment in addition to the remuneration due from the part-time employment, which – similar to partial retirement – compensates for a large part of the financial losses.
Our ambitions
Occupational health and safety is highly relevant for the Fresenius Group. The aim is to define a Group-wide KPI that will serve as a long-term performance indicator and be reported. Further details can be found in the Compensation Report.
Our business segments manage their occupational health and safety measures in line with segment-specific ambitions.
Fresenius Medical Care plans to include a further global indicator, the Lost Time Injury Frequency Rate (LTIFR) in the reporting beginning in 2023.
Fresenius Kabi wants to continue the improvement of its occupational health and safety management. The ambition of the business segment is to prevent all work-related accidents and continually improve workplace safety. To achieve this, Fresenius Kabi is developing appropriate occupational health and safety programs and measures with local managers.
The introduction of a system for the comprehensive recording of occupational and commuting accidents is planned for all German Helios hospitals. The result of a pilot project will be evaluated in the first quarter of 2023. In future, key figures such as the LTIFR are also to be collected.
A corresponding pilot phase was carried out in 2022. For the introduction of the system, Fresenius Helios is closely cooperating with the German accident insurance institutions and internal managers. In the future, Helios Germany will also collect data for preventive health and safety at work purposes. For Helios Spain, the central corporate strategy provides process ambitions as well as KPI targets for occupational health and safety at the clinics.
Fresenius Vamed currently collects relevant key figures locally that may result from occupational accidents. In the future, changes in occupational health management will also be evaluated to an increasing extent. For this purpose, a survey was conducted for the first time in the reporting year to determine the extent to which employees take advantage of offers for workplace health promotion.
COVID-19 pandemic
During the ongoing COVID-19 pandemic in the reporting year, the safety and health of our patients, employees, their families, and the communities in which we work were again the focus of our response activities. For their protection and to secure the continuity of all operational and administrative activities, we have developed specific protection concepts, measures, and working regulations. We reapplied these in 2022 depending on the pandemic situation and based on regulatory and internal assessment. With regard to hygiene in particular, we had to take special measures. At times, our employees also had to face restrictions, e. g., by wearing personal protective equipment (PPE), or carry out additional work, for instance in the case of necessary admission controls.
There has been continuous and direct communication with the employees of all sites and companies ever since the beginning of the pandemic. The specially established crisis teams communicated the hygiene and medical requirements as part of regular communication in the Group, taking into account the respective local official regulations and country-specific ordinances and laws.